- Highmark Health (Denver, CO)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Humana (Denver, CO)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** ** Medicaid Insurance Product Management and Wellness Strategy** will ... caring community and help us put health first** Humana Medicaid is seeking exceptional candidates to join our ...(10-25% of time) This position is open to working remote within the US but prefer the qualified candidate… more
- Humana (Denver, CO)
- …a part of our caring community and help us put health first** The Director , Actuarial of Medicaid Pricing provides actuarial support across a broad range ... understanding of how organization capabilities interrelate across the function or segment. The Director , Actuarial of Medicaid Pricing may be responsible for any… more
- Prime Therapeutics (Denver, CO)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions -RPH/PharmD required- REMOTE **Job Description ... Summary** Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Business Development team. Responsible for… more
- Humana (Denver, CO)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... decentralized systems. * Google Cloud Professional Machine Learning Engineer * Agile Remote /WAH requirements: + WAH requirements: Must have the ability to provide a… more
- Humana (Denver, CO)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Elevance Health (Denver, CO)
- …reviews within our Medicaid and Medicare programs.** The **Behavioral Health Medical Director ** is responsible for the administration of behavioral health ... proud member of Elevance Health's family of brands, offering Medicaid and Medicare plans in several states. We also...opportunities. May serve as a resource to staff including Medical Director Associates. How you will make… more
- Humana (Denver, CO)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director reviews cases of diverse scope...protect member PHI / HIPAA information This is a remote position reporting to Grievance and Appeals Director… more
- State of Colorado (Denver, CO)
- Division Director of Children, Youth and Family Behavioral Health Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4646110) Division ... Director of Children, Youth and Family Behavioral Health Salary...and accreditation standards governing behavioral health services, including HIPAA, Medicaid , and state licensing requirements. + Flexibility to adjust… more
- Cardinal Health (Denver, CO)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- HealthEdge Software Inc (Denver, CO)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products ... Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other...Work across multiple time zones in a hybrid or remote work environment. + Long periods of time sitting… more
- CVS Health (Denver, CO)
- …health care more personal, convenient and affordable. **Position Summary** As the Director of Commercialization and Growth, part of the Health Care Delivery business ... sales strategies and growth objectives. Note**:** _This is a remote role and can be anywhere in the continental...Experience in Managed Care space (Medicare Advantage or Managed Medicaid ) a plus. + Knowledge of health plan economics… more
- Prime Therapeutics (Denver, CO)
- …every decision we make. **Job Posting Title** Pharmacy Network Manager - Remote **Job Description** The Pharmacy Network Manager is responsible for development and ... industry; including 3 years of managed care experience in medical or pharmacy network contracting + Must be eligible...+ Knowledge of and experience within health care/PBM industry, Medicaid , Medicare and health plans + Familiarity with contract… more
- State of Colorado (Denver County, CO)
- Medical Technologist(CLS, MLS)/ Medical Laboratory Technician-CO Mental Health Hospital in Fort Logan Print ... (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4652724) Apply Medical Technologist(CLS, MLS)/ Medical Laboratory Technician-CO Mental Health… more
- BrightSpring Health Services (Englewood, CO)
- …home infusion providers in the country. The Collection Manager will report to the Director of Revenue Cycle Management. This position can be hybrid OR fully ... remote . Mountain Time Zone. As a core member of...banking and the security of patient financial information. * Medical , Dental & Vision Benefits plus, HSA & FSA… more
- State of Colorado (Denver, CO)
- …six treatment milieus serving civil and forensic individuals. Medical services, occupational therapy, neuropsychological-rehabilitation services, and trauma-informed ... Momentum referrals, obtaining identification, securing a payee, applying for Medicaid /Medicare, and submitting referrals to potential discharge locations + must… more
- State of Colorado (Denver, CO)
- …by the Joint Commission and certification by the Centers for Medicare/ Medicaid Services are maintained. The Quality Management Department guides the Colorado ... CMS regulations pertaining to hospitals + Hospital (Psychiatric and/or Medical ) experience + Experience in working with and analyzing...Board or request a review by the State Personnel Director . An appeal or review must be submitted on… more
- State of Colorado (Denver, CO)
- …the Joint Commission on Accreditation of Hospitals, the Center for Medicare and Medicaid , the Office of Civil and Forensic Mental Health, 27-65 Regulations, and the ... Board or request a review by the State Personnel Director . An appeal or review must be submitted on...Contribution Plan www.copera.org plus 401(k) and 457 plans + Medical and dental health plans + Employer supplemented Health… more
- Adams County Government (Westminster, CO)
- …classification Hybrid -- Job duties and expectations allow for onsite and remote work scheduled every week. Employees in this classification are regularly scheduled ... on the County needs and as determined by Department Director . Hybrid classified roles can be onsite more than...a high degree of accuracy. + As required, completes Medicaid billing documentation per agency and state expectations and… more